Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020

Details

• Personal Author:
  Morris, Sapna Bamrah ; Schwartz, Noah G. ; Patel, Pragna ; Abbo, Lilian ; Beauchamps, Laura ; Balan, Shuba ; Lee, Ellen H. ; Paneth-Pollak, Rachel ; Geevarughese, Anita ; Lash, Maura K. ; Dorsinville, Marie S. ; Ballen, Vennus ; Eiras, Daniel P. ; Newton-Cheh, Christopher ; Smith, Emer ; Robinson, Sara ; Stogsdill, Patricia ; Lim, Sarah ; Fox, MD, Sharon E. ; Richardson, Gillian ; Hand, Julie ; Oliver, Nora T. ; Kofman, Aaron ; Bryant, Bobbi ; Ende, Zachary ; Datta, Deblina ; Belay, Ermias ; Godfred-Cato, Shana
• Corporate Authors:
  CDC-19 COVID- Response Team. ; Centers for Disease and Prevention (U.S.)Epidemic Intelligence Service. ; Leonard M. Miller School of Medicine. ; New York City Department of Health and Mental Hygiene. ; Massachusetts General Hospital. ; Broad Institute. ; Maine Center for Disease Control and Prevention. ; University of Southern Maine. ; Maine Medical Center (Portland, Me.) ; Minnesota. Department of Health, ; Lousiana State University Health Sciences Center. ; Southeast Louisiana Veterans Healthcare System. ; Louisiana. Department of Health. ; Veterans Administration Hospital (Atlanta, Ga.). Section of Infectious Diseases. ; Emory University School of Medicine. Division of Infectious Diseases. ; Oak Ridge Institute for Science and Education.
• Description:
  What is already known about this topic? Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe complication of SARS-CoV-2 infection in children and adolescents. Since June 2020, several case reports and series have been published reporting a similar multisystem inflammatory syndrome in adults (MIS-A).
  
  What is added by this report? Cases reported to CDC and published case reports and series identify MIS-A in adults, who usually require intensive care and can have fatal outcomes. Antibody tTesting was required to identify SARS-CoV-2 infection in approximately one third of 27 cases.
  
  What are the implications for public health practice? Clinical suspicion and indicated SARS-CoV-2 tTesting, including antibody tTesting, might be needed to recognize and treat adults with MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this condition. Ultimately, the recognition of MIS-A reinforces the need for Prevention efforts to limit spread of SARS-CoV-2.
  
  During the course of the coronaVirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1–3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4–6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the Virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody tTesting in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody tTesting might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections, interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition.
  
  Suggested citation for this article: Morris SB, Schwartz NG, Patel P, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020. MMWR Morb Mortal Wkly Rep. ePub: 2 October 2020.
  
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• Content Notes:
  Case Reports -- Published Case Series -- Discussion -- Acknowledgments -- Table 1 -- Table 2 -- References.
• Subjects:
  Adult CoronaVirus Infection/Complications CoronaVirus Infections COVID-19 Female Humans Male Pandemics Pneumonia, Viral Pneumonia, Viral/Complications Systemic Inflammatory Response Syndrome

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• Source:
  MMWR: Morbidity and Mortality Weekly Report 2020; v. 69 Early Release
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Document Type:
  Journal Article
• Place as Subject:
  United Kingdom ; United States
• Pages in Document:
  8 pdf pages
• Volume:
  69
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:ab80b9b3053bdee0e8e1da6d9a52a2c159fd226968956c65f20c1fc28dc6195ead8089239fcd6daaaf18def2447ab909333701c1b01baebd586b8048d32855c3
• Download URL:
  https://stacks.cdc.gov/view/cdc/94677/cdc_94677_DS1.pdf
• File Type:
  [PDF - 168.50 KB ]